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Prescriptions & Providers

Prescriptions & Providers

When it come to Medicare, one size does not fit all. Whether you’re enrolling in Medicare for the first time or thinking about changing your coverage, you’ll want to look at your options and know what’s important to you.

Will I Have Prescription Drug Coverage?

Prescription drugs aren't covered by Original Medicare. Once you’ve enrolled in Medicare, there are two ways to get Medicare prescription drug coverage:

  • Medicare Prescription Drug (Part D) Plan

    You can purchase a standalone Medicare Prescription Drug (Part D) plan to help pay for your prescription drug costs. You can have a standalone Part D plan in combination with any of these plans:

    • Original Medicare
    • Original Medicare plus a Medicare Supplement insurance plan
    • A Medicare Advantage Private Fee-for-Service plan that doesn't include drug coverage
    •  A Medicare Savings Account (MSA)

  • Medicare Advantage (Part C) Plan

    A Medicare Advantage (Part C) Prescription Drug (MAPD) plan can offer the convenience of having your prescription drug coverage in the same plan as your hospital, doctor, and other benefits.

    Most Medicare Advantage plans include prescription drug coverage and have a lower premium than a standalone Part D plan.

 

Remember: Each Medicare Advantage plan and Medicare prescription drug plan covers a certain set of prescription drugs. Be sure to check each plan’s drug list (also known as a formulary) to see if the prescription drugs you take will be covered. If you already have prescription drug coverage, make sure your prescriptions will be covered next year, too

Will I Still Be Able to See My Current Provider(s)?

If staying with your current provider or doctor is important to you, check to see if a plan has a provider network. If it does, you’ll want to know if your doctor is in that plan’s network. Some plans will require you to stay in-network, other plans allow you to use providers outside the network, and still other plans don’t have a network at all. Medicare Supplement plans let you see any provider or specialist without network restrictions, as long as they accept Medicare patients.

When thinking about plans, find out:

  1. Will I have to choose providers from a network?
  2. Will my providers accept the plan’s terms? If not, are there providers near me who will?
  3. Will I need a referral from a primary care provider to see a specialist?

  • Original Medicare (Parts A and B)

    • Providers: See any provider who accepts Medicare
    • Specialist referrals: No referral needed to see a specialist who accepts Medicare.

  • Medicare Supplement (Medigap) Plans

    • Providers: See any provider or specialist without network restrictions, as long as they accept Medicare patients.
    • Specialist referrals: No referral needed to see a specialist.

  • Medicare Advantage (Part C) Plans

    Providers:

    • Network plans: If a plan has a provider network (for example, an HMO), you can save money by using a provider in the plan's network. Some plans allow you to use providers outside the network, usually for a higher cost.
    • Non-Network plans: This type of Medicare Advantage plan may not have a provider network and allows you to see any provider that accepts Medicare and the plan’s terms.


    Specialist referrals:     Some Medicare Advantage plans require a referral to see a specialist, some do not.

 

Remember: If a plan has a provider network, that network can change each year. If your current plan has a provider network, be sure to check if your provider will be in the network next year. You can switch plans during the Medicare Annual Enrollment Period if your provider won’t be in your plan’s network next year.

 

Enroll with RMHP

RMHP is here to help! Here’s how you can enroll in an RMHP Medicare Advantage or Dual Special Needs Plan.

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Choose a plan and enroll online.

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Call 866-568-3706 (TTY:711), and speak to a licensed agent.

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Find a meeting in your community.

 

Medicare Disclaimer

This page was last updated: 10/01/2021. Please call to confirm you have the most up to date information about our Medicare plans.

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Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan's contract renewal with Medicare. Other pharmacies, physicians, providers are available in our network. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult http://www.medicare.gov.   Every year, Medicare evaluates plans based on a 5-star rating system.  If you need help finding a network provider, please call 800-346-4643  (TTY 711) or visit www.rmhpMedicare.org to access our online searchable directory. If you would like a provider directory mailed to you, you may call the number above, request one at the website link provided above, or email customer_service@RMHP.org

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Since 1977, Colorado retirees like you have trusted RMHP to get the most out of their Medicare benefits. Enjoy easy enrollment, flexible options, and a large provider network when you choose RMHP. Let us help you enjoy your retirement.

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